Question:
The two policies that I could choose from Both say NO

I actually have two questions. I have been checking into my ins coverage and it looked as if mine wouldn't cover any obesity surgery. So I called them to ask specifically if and what the exclusions were. They told me that Any surgery that was weight related was not covered even if there was a medical need for it. ie: joint pain, sob, apnea, etc if the reason for the problem was do the excess weight. They said it did not matter even if morbid obesity was the cause, No weight loss surgery would be covered. So I contacted my Husbands ins company and checked with them...he has open enrollment right now and he can only change his coverage 1 time a year. So I thought I'd check with his and see if there were any exclusions. NO they do not have Any pre-existing condition clauses. However No they will not cover ANY weight loss surgeries even if there is a medical problem involved, or morbid obesity. They essentially told me the exact same thing my ins co said. If you have this or that medical problem and the surgery will correct it we won't pay for it IF its caused by excessive weight. Do I have any recourse with this?? Even if my surgeon lists reason for surgery as joint pain/deterioration, sleep apnea, etc. Obviously their review board is going to realize it's weight related or I wouldn't be having an RNY, since my stomach is Not directly attached to my knees or feet. So how would that help? Also I probably hurt myself by calling them and asking them because they wouldn't give me any information until I gave them my soc sec # and policy # on my ins and my husbands on his, so if they make note of incoming inquires they will know that it's due to morbid obesity. By the way my BMI is 51.8 but I guess that doesn't matter to them. Any answers would be greatly appreciated. Sorry this was so long. thanks Deb    — [Anonymous] (posted on October 28, 1999)

October 28, 1999
I would shoot for it anyhow. You may have to get tough but in the end you may win. Its possible that they may cover because it is more cost effective than a lawsuit or to have you die from morbid obesity. You may have to get a lawyer though and play hardball. Even though thet generally do not cover they can always make an exception
   — snicklefritz

October 28, 1999
From your question it appears that you have only approached your current plan and your husband's current plan yet you indicate that your husband's job offers annual open seasons. This means he has a choice of several plans. Perhaps you could research the other plans. Where I work we also have open season once a year and the plans all differ on WLS policy. Good Luck.
   — [Anonymous]

October 29, 1999
Deb. . . did you see the exclusion in writing (in the policy)? When I called the insurance co. they told me that it wasn't covered. period. but there was no exclusion in the policy. I thinkcustomer service depts. could be instructed to deny things verbally.
   — [Anonymous]

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